From the Department of Ophthalmology (C.A., F.L., D.V., J.C., R.B., M.S.G., P.J.M.B.), Massachusetts Eye and Ear Infirmary.
From the Department of Ophthalmology (C.A., F.L., D.V., J.C., R.B., M.S.G., P.J.M.B.), Massachusetts Eye and Ear Infirmary; Department of Microbiology and Immunology (F.L., D.V., M.S.G.), Harvard Medical School, Boston, Massachusetts, USA.
Am J Ophthalmol. 2023 Nov;255:43-56. doi: 10.1016/j.ajo.2023.06.016. Epub 2023 Jun 19.
Ocular bacterial infections are important causes of morbidity and vision loss. Early antimicrobial therapy is necessary to save vision, but their efficacy is increasingly compromised by antimicrobial resistance (AMR). We assessed the etiology of ocular bacterial infections seen at Massachusetts Eye and Ear and investigated the molecular epidemiology and AMR profiles of contemporary isolates.
Laboratory investigation.
We used a combination of phenotypic tests and genome sequencing to identify the predominant lineages of leading ocular pathogens and their AMR profiles.
A total of 1601 isolates were collected from 2014 to 2021, with Staphylococcus aureus (n = 621), coagulase-negative staphylococci (CoNS) (n = 234), Pseudomonas aeruginosa (n = 213), Enterobacteriaceae (n = 167), and Streptococcus pneumoniae (n = 95) being the most common. Resistance was high among staphylococci, with methicillin resistance (MR) detected in 28% of S aureus and 39.8% of CoNS isolates. Multidrug resistance (MDR) was frequent among MR staphylococci (MRSA 60%, MRCoNS 76.1%). The population of S aureus isolates consisted mainly of 2 clonal complexes (CCs): CC8 (26.1%) and CC5 (24.1%). CC5 strains carried a variety of AMR markers, resulting in high levels of resistance to first-line therapies. Similarly, the population of ocular Staphylococcus epidermidis was homogenous with most belonging to CC2 (85%), which were commonly MDR (48%). Conversely, ocular S pneumoniae, P aeruginosa, and Enterobacteriaceae were often susceptible to first-line therapies and grouped into highly diverse genetic populations.
Our data showed that ocular bacterial infections in our patient population are disproportionately caused by strains that are resistant to clinically relevant antibiotics and are associated with major epidemic genotypes with both community and hospital associations.
眼部细菌感染是导致发病率和视力丧失的重要原因。为了挽救视力，必须尽早进行抗菌治疗，但由于抗菌药物耐药性（AMR）的增加，其疗效越来越受到影响。我们评估了在马萨诸塞眼耳医院就诊的眼部细菌感染的病因，并研究了当代分离株的分子流行病学和 AMR 特征。
实验室研究。
我们使用表型检测和基因组测序相结合的方法，鉴定主要眼部病原体的优势谱系及其 AMR 特征。
共收集了 2014 年至 2021 年的 1601 株分离株，其中金黄色葡萄球菌（n=621）、凝固酶阴性葡萄球菌（CoNS）（n=234）、铜绿假单胞菌（n=213）、肠杆菌科（n=167）和肺炎链球菌（n=95）最为常见。葡萄球菌的耐药率较高，金黄色葡萄球菌和 CoNS 分离株的耐甲氧西林率（MR）分别为 28%和 39.8%。耐多药（MDR）在 MR 葡萄球菌中很常见（MRSA 60%，MRCoNS 76.1%）。金黄色葡萄球菌分离株的主要由 2 个克隆群（CC）组成：CC8（26.1%）和 CC5（24.1%）。CC5 菌株携带多种 AMR 标记物，导致对一线治疗药物的耐药率较高。同样，眼部表皮葡萄球菌的种群也具有同源性，大多数属于 CC2（85%），通常为 MDR（48%）。相反，眼部肺炎链球菌、铜绿假单胞菌和肠杆菌科对一线治疗药物通常敏感，并分为高度多样化的遗传群体。
我们的数据表明，我们患者人群中的眼部细菌感染主要由对临床相关抗生素耐药的菌株引起，与具有社区和医院关联的主要流行基因型有关。
